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1 � <br /> CITY OF ORONO * 2 0 1 6 - 0 1 5 3 6 * <br /> � 2750 KELLEY PARKWAY DATE ISSUED: 12/14/2016 <br /> ORONO,MN 55356- <br /> 952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 2170 PROSPECT AVE <br /> PIN : 10-117-23-31-0018 <br /> LEGAL DESC : LJNPLATTED 10 117 23 <br /> : LOT '000 BLOCK 000 <br /> PERMIT TYPE : ESCROW FEE-APPLICANT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYP� : ESCROW FEE-APPLICANT <br /> NOTE: THIS$2500 ESCRdW IS TIED TO ZONING APPLICATION 17-3889 <br /> APPLICANT ESCROW FEE-APPLICANT 2,500.00 <br /> TOTAL 2,500.00 <br /> WHITE,TIM&JANE Payment(s) <br /> 16820 COLJNTY ROAD 122 CHECK 5002 2,500.00 <br /> MAYER,MN 55360- <br /> OWNER <br /> WHITE,TIM&JANE <br /> 16820 COLTNTY ROAD 122 <br /> MAYER,MN 55360- <br /> AGREEMENT AN SWORN STATEMENT <br /> The work for which this permit is lissued shall be performed according to <br /> the approved plans and specificati ns,applicable City approvals,and the <br /> State Building Code. This permit,is for only the work described and dces <br /> not grant permission for additiona�or related work which requires separate <br /> permits. All provisions of Iaws d ordinances goveming this type of work <br /> shall be compied with whether o�ot specified herein.This permit will <br /> expire and become null and void i construction authorized is not <br /> commenced within I80 days of the date of issuance,or if construction is <br /> suspended for a period of I80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with tha State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> / / <br /> Applicant Permitee Signature Date Issued By Signature Date <br />